| NPI | 1740561679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05010015A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11414) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2021-09-10 |