| NPI | 1366119034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 13850) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 13850) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2023-09-28 |