| NPI | 1083902647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05010551A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006074) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2013-06-18 |