| NPI | 1609387034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16414) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21515) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2025-09-02 |