| NPI | 1457580912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT PT.011889) |
| 225100000X Physical Therapist (Licence: TN 10924) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2020-12-02 |