| NPI | 1417670019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14509) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2025-10-29 |