| NPI | 1104239458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 9964) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7156) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2019-10-03 |