| NPI | 1972535813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P8045) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 8045) |
| 225100000X Physical Therapist (Licence: TN 7697) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-09-26 |