| NPI | 1669744983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GU PT-105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-3401) |
| 225100000X Physical Therapist (Licence: GU PT-90) | |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2023-04-25 |