| NPI | 1093599938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 16363) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2026-02-03 |