| NPI | 1265724322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03788) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000008305) |
| 225100000X Physical Therapist (Licence: OR 6162) | |
| 225100000X Physical Therapist (Licence: AR PT3127) | |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2024-04-24 |