| NPI | 1578266987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: IN 05015011A) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-12-19 |