| NPI | 1639681216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2074) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13442) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2021-08-17 |