| NPI | 1093816464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT5997) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TN 5997) |
| 225100000X Physical Therapist (Licence: GA PT7553) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2017-12-06 |