| NPI | 1538697842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012379A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32216) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |