| NPI | 1912912791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1375) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-02-09 |