| NPI | 1174046072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12018) |
| 225100000X Physical Therapist (Licence: MN 10758) | |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2025-04-23 |