| NPI | 1760627038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-3215) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2018-03-17 |