| NPI | 1184812844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH5085) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2024-08-16 |