| NPI | 1457073041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 5015) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO CP014856T) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2022-09-12 |