| NPI | 1386205102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 4625) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5661) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2020-09-14 |