| NPI | 1043818081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16686) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-5076) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2025-04-10 |