| NPI | 1538826748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS CP003037T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14003) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2022-11-02 |