| NPI | 1063199404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 15122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 009567) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2026-06-17 |