| NPI | 1265005920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014814A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021001542) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2022-10-28 |