| NPI | 1780938571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011726A) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2022-07-21 |