| NPI | 1457833113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 003712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05006204A) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2025-02-10 |