| NPI | 1053176743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP025409T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05003537A) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-11-29 |