| NPI | 1285026930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11417) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4235) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2018-06-14 |