| NPI | 1427509785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11533) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MS PT5196) | |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2018-12-13 |