| NPI | 1114132560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000007556) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 9099) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2019-02-25 |