| NPI | 1518459882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015443A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 99086597A) |
| Enumeration Date | 2018-06-03 |
| Last Update Date | 2024-02-09 |