| NPI | 1053543314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT8461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8461) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2025-04-30 |