| NPI | 1720500150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5304) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26530) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 26530) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2021-11-19 |