| NPI | 1780350223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14589) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT.61228639) |
| 225100000X Physical Therapist (Licence: VA 2305214545) | |
| 225100000X Physical Therapist (Licence: TN CP014520T) | |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2022-08-17 |