| NPI | 1285388538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5915-0) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0017959) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2024-05-30 |