| NPI | 1154676344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5106) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207450) |
| 225100000X Physical Therapist (Licence: AR 5106) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2022-05-02 |