| NPI | 1710233200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013599A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2012017473) |
| 225100000X Physical Therapist (Licence: IL 070-026503) | |
| 225100000X Physical Therapist (Licence: MO 2012027758) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2022-04-07 |