| NPI | 1114364379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-21924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT5717) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2024-01-05 |