| NPI | 1376678128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05006820A) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: IN 05006820A) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |