| NPI | 1134290331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5295) |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2026-02-27 |