| NPI | 1396478525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19888) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2022-07-28 |