| NPI | 1750375952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000003293) |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology (Licence: TN PT0000003293) |
| 2251S0007X Physical Therapist Sports (Licence: TN PT0000003293) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: TN PT0000003293) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2007-07-08 |