| NPI | 1174779888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07385) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2014-10-10 |