| NPI | 1497276935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10612) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2017-07-06 |