| NPI | 1295093151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015471A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06004125A) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2024-03-26 |