| NPI | 1407406176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12543) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2020-06-19 |