| NPI | 1275178527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016682) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013342A) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2019-11-11 |