| NPI | 1811928823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7079) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7079) |
| 225100000X Physical Therapist (Licence: MS 3491) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2015-03-30 |