| NPI | 1033599550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006561) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007788A) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2016-07-09 |