| NPI | 1487197125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-8842) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225100000X Physical Therapist | |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2023-08-02 |