| NPI | 1821614082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12829) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: TN 12829) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-10-13 |