| NPI | 1942748934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-4936) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41787) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2024-08-28 |