| NPI | 1669912168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12850) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2021-11-01 |