| NPI | 1043854441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP044823T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070024810) |
| 225100000X Physical Therapist (Licence: IN 05013763A) | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2025-06-25 |