| NPI | 1154672392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005017A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016704) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2021-05-28 |