| NPI | 1114594561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14711) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021017483) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-09-16 |