| NPI | 1811772361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16422-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-5780-0) |
| 225100000X Physical Therapist (Licence: ND CP022553T) | |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2023-08-31 |