| NPI | 1003157538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006189) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011066A) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2019-04-29 |