| NPI | 1053711903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 9652) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 8465) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2025-09-04 |