| NPI | 1346699436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS CP026181T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS CP004290T) |
| 225100000X Physical Therapist (Licence: TN 11530) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2023-11-29 |