| NPI | 1992037766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005584) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010200A) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2020-12-03 |