| NPI | 1962803320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008154) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2020-12-31 |