| NPI | 1316903552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 2044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT 2044) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-08-30 |