| NPI | 1396106985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-20168) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4418) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2021-03-11 |