| NPI | 1881249373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12600) |
| 225100000X Physical Therapist (Licence: SC 12829) | |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2025-08-21 |