| NPI | 1366004202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008241) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12340) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2021-05-18 |