| NPI | 1962744979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1333218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009899A) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2021-03-03 |