| NPI | 1174392823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16621) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1386896) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2025-08-08 |