| NPI | 1437595097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT9592) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP035056T) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2025-05-22 |