| NPI | 1023885126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5847-0) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303076) |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2023-12-08 |