| NPI | 1982683371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 004866) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011011A) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2024-01-12 |