| NPI | 1407167299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 71011576A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8497) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-01-24 |