| NPI | 1295380293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT6981) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10389) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-02-26 |