| NPI | 1710177316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 07985) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004173) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2021-12-04 |