| NPI | 1508053877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10523) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH 5164) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2018-10-18 |