| NPI | 1851114979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 009183) |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2025-03-03 |