| NPI | 1104121821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT2731) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MS 640881013) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2021-02-24 |