| NPI | 1225013873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05001458A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 7774) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2021-10-04 |