| NPI | 1114247574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7433) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8656) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-12-16 |