| NPI | 1942868062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9675) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2025-09-30 |