| NPI | 1124002795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05001580A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005221) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2011-02-08 |