| NPI | 1396463691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 5138) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-08-01 |