| NPI | 1275025223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT6453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN CP002847T) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2021-03-29 |