| NPI | 1376623967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012023A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 22443) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-11-16 |