| NPI | 1427482686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT5272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9816) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2021-07-19 |