| NPI | 1396736914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 5784) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT7171) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2013-11-04 |