| NPI | 1366730137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008658) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009882A) |
| 225100000X Physical Therapist (Licence: TN 9820) | |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2022-07-21 |