| NPI | 1750736427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011991A) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2017-06-22 |