| NPI | 1972464055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP051278T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 16530) |
| Enumeration Date | 2025-11-19 |
| Last Update Date | 2025-11-26 |