| NPI | 1285125013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014859A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 017465) |
| 225100000X Physical Therapist (Licence: FL PT017465) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2023-05-03 |