| NPI | 1558485607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8794) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN PTA0000003175) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2010-09-14 |