| NPI | 1275765745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011639A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5707) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2019-02-14 |