| NPI | 1376674051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 1935) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305006625) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2018-07-11 |