| NPI | 1255615464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 5893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9156) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2019-10-04 |