| NPI | 1093270951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007619) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013271A) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2020-06-16 |