| NPI | 1881491686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216287) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 15479) |
| Enumeration Date | 2025-02-27 |
| Last Update Date | 2025-03-19 |