| NPI | 1932625977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60748598) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2021-11-09 |