| NPI | 1578088555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14778) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11691) |
| 225100000X Physical Therapist (Licence: GA CP008378T) | |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2025-11-06 |