| NPI | 1043794548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012847A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 13603) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2023-02-07 |