| NPI | 1093953572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8669) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-0552) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2020-10-30 |