| NPI | 1730498973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 6356) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8814) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2023-04-19 |