| NPI | 1598366221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215209) |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2025-12-30 |