| NPI | 1164821724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10084) |
| 225100000X Physical Therapist (Licence: IN 05012340A) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2020-06-17 |