| NPI | 1972888394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 3414) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1211289) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2020-07-27 |