| NPI | 1114979622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011255A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4088) |
| 225100000X Physical Therapist (Licence: OH PT.012408) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-09-16 |