| NPI | 1891930319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7188) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH3096) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2017-12-14 |