| NPI | 1407587561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 5799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2022022556) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2026-05-19 |