| NPI | 1275561243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5614) |
| 225100000X Physical Therapist (Licence: TN 104) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-04-05 |