| NPI | 1588094650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9852) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2023-08-04 |