| NPI | 1700289139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10599) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208912) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2017-11-22 |