| NPI | 1487748679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013657A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1269) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-01-07 |