| NPI | 1750676508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP033500T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021219) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2025-12-22 |