| NPI | 1831899020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT-5264) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |