| NPI | 1972643096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP001275T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007458A) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-03-10 |