| NPI | 1659771954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-5324) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62383) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2026-09-16 |