| NPI | 1528014073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT3860) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT6468) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2008-02-25 |