| NPI | 1346721628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018028642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06039) |
| 225100000X Physical Therapist (Licence: TN 12151) | |
| 225100000X Physical Therapist (Licence: AR PT4590) | |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2022-01-04 |