| NPI | 1184239725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015003A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10407) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2023-12-12 |