| NPI | 1427888080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16282) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2024031309) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-12-20 |