| NPI | 1164486916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 5498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7016) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2016-04-07 |