| NPI | 1982945994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7633) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 7633) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2024-01-25 |