| NPI | 1659609923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT0345) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000008246) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2009-11-25 |