| NPI | 1104431972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP043939T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN CP058135T) |
| 225100000X Physical Therapist (Licence: KY 008017) | |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2026-06-01 |