| NPI | 1134255763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8889) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT18521) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2023-10-03 |