| NPI | 1588788251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05008974A) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 027952) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-03-27 |