| NPI | 1558728584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014878A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225100000X Physical Therapist | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2026-03-05 |