| NPI | 1922673383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7190) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 7190) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2024-08-08 |