| NPI | 1386078459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-3731) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT28331) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2024-05-06 |