| NPI | 1114276508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05010966A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006077) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2013-07-01 |