| NPI | 1003609439 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05016130A) | 
| Additional Taxonomies | 225100000X Physical Therapist | 
| Enumeration Date | 2025-05-28 | 
| Last Update Date | 2025-08-22 |