| NPI | 1922625680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12845) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS CP004850T) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2021-04-26 |