| NPI | 1235868662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014408A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501020119) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2023-06-07 |