| NPI | 1760055313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14602) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 3240) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2024-01-23 |