| NPI | 1972669646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT1729) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT 8230) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2018-04-30 |