| NPI | 1285819284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05009502A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013619) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2011-07-20 |