| NPI | 1659828622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VI 218) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT011002) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2024-08-08 |