| NPI | 1598214850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27692) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10992) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2020-09-03 |