| NPI | 1447724539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 41252) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2025-10-21 |