| NPI | 1437870193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014809A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049209) |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2025-06-04 |