| NPI | 1598382541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7283) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12890) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2023-09-20 |