| NPI | 1740647262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012351A) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2021-05-20 |