| NPI | 1487931184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005612A) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: MO 02179) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2024-04-12 |