| NPI | 1649833880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12154) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212662) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2019-04-14 |