| NPI | 1821211293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 5352) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000005352) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2021-04-29 |