| NPI | 1497107858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16324) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31291) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2025-04-08 |