| NPI | 1740929975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT5460) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-5460-0) |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2022-07-27 |