| NPI | 1265080717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12807) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 096583) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2020-02-05 |