| NPI | 1780296558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05016209A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 19493) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2026-01-23 |