| NPI | 1952845562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007045) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2018-04-19 |