| NPI | 1376008870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP008397T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019003990) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2021-10-15 |