| NPI | 1366827180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011987A) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2022-04-22 |