| NPI | 1942836150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12754) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2020-04-24 |