| NPI | 1306513841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP022613T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05014254A) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2023-10-25 |