| NPI | 1740893718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA Cp038600T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05014197A) |
| 225100000X Physical Therapist (Licence: AL PTH9937) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2026-02-24 |