| NPI | 1568996064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS CP019222T) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-04-19 |