| NPI | 1982624250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000005712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004863) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-07-17 |