| NPI | 1578825915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011818) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010868A) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2017-02-24 |