| NPI | 1891295879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11578) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17499) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |