| NPI | 1063429504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000004657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39373) |
| 225100000X Physical Therapist (Licence: AL PTH8689) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-11-01 |