| NPI | 1275232662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015151A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501302493) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-07-10 |