| NPI | 1346270162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005606A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1088763) |
| 225100000X Physical Therapist (Licence: IL 70014452) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2017-12-21 |