| NPI | 1942549035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 14161) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT0000009312) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2014-05-10 |