| NPI | 1811102700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000007124) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN PT0000007124) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-06-15 |