| NPI | 1720351034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 26829) |
| 225100000X Physical Therapist (Licence: WV 004564) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2025-01-06 |