| NPI | 1568147122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16241) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 39977) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2025-02-13 |