| NPI | 1982372264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 234158) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 13460) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2025-10-21 |