| NPI | 1063861060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12255) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2023-05-29 |