| NPI | 1427392422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11133) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022456) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-10-17 |