| NPI | 1114473162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014543A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9221) |
| 225100000X Physical Therapist (Licence: ME PT4703) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2022-04-14 |