| NPI | 1215396890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10746) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: TN 10746) | |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2020-01-16 |