| NPI | 1528745098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16691) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22354) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2025-11-13 |