| NPI | 1689661662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: TN PT0000007480) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 17409) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2014-07-08 |