| NPI | 1194325712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 097556) |
| Enumeration Date | 2020-11-01 |
| Last Update Date | 2020-11-01 |