| NPI | 1801374053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2157) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2020-03-17 |