| NPI | 1710369327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-0779) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-07-18 |