| NPI | 1619297926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9385) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8649) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-06-24 |