| NPI | 1669979126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 5186) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NH 1239) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-08-20 |