| NPI | 1568765188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05009993A) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: IN 05009993A) |
| 2251N0400X Physical Therapist Neurology (Licence: IN 05009993A) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2012-01-12 |