| NPI | 1184140097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012573A) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2019-04-04 |