| NPI | 1457783391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011316A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006252) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2014-02-14 |