| NPI | 1174053482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013774A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4485) |
| 225100000X Physical Therapist (Licence: MN 10731) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-07-21 |