| NPI | 1427145333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH4747) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-06-05 |