| NPI | 1518631738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7324) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 218768) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2026-06-04 |