| NPI | 1568907954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 4903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8451) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2024-07-30 |