| NPI | 1588866008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010596A) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2022-07-21 |