| NPI | 1669927000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-4640) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT4640) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2022-07-21 |