| NPI | 1629199864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05001793A) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 05001793A) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-01-18 |