| NPI | 1902887375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05003020A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207421) |
| 225100000X Physical Therapist (Licence: OH PT-04982) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2019-04-11 |