| NPI | 1891937850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012048) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2024-04-01 |