| NPI | 1922856814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216496) |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2025-03-03 |