| NPI | 1497066146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 004270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007849A) |
| 225100000X Physical Therapist (Licence: TN 6201) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2010-06-28 |