| NPI | 1528580750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 4419) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2018-06-05 |