| NPI | 1508272881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013300A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037517) |
| 225100000X Physical Therapist (Licence: MD 27234) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2020-10-19 |