| NPI | 1871047837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 4832) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3729) |
| 225100000X Physical Therapist (Licence: LA 09475) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2023-03-28 |