| NPI | 1255315420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05002356A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005219) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-09-01 |