| NPI | 1851981492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008083) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013823A) |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2023-02-10 |