| NPI | 1477319028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP044424T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05015436A) |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2025-05-19 |