| NPI | 1154716322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist Neurology (Licence: ID PT-2111) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2025-07-01 |