| NPI | 1396728713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8081) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TN AT0000000247) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2019-04-10 |