| NPI | 1982836292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 9528) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204911) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2020-03-12 |