| NPI | 1013339167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011988A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023241) |
| 225100000X Physical Therapist (Licence: MA 20934) | |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2016-04-21 |