| NPI | 1871831305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015398A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6249) |
| 225200000X Physical Therapy Assistant (Licence: CA 9047) | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2024-09-12 |