| NPI | 1730460486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 3098) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: UT 8036468-2401) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2021-10-08 |