| NPI | 1609345487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IN 05014434A) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2022-06-28 |