| NPI | 1548646250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 4027) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR 4027) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2018-12-14 |