| NPI | 1801235460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-3242) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT1480) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2022-11-09 |