| NPI | 1487902060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011925A) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2012026873) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2018-08-22 |