| NPI | 1063709814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7718) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT9013) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2024-05-30 |