| NPI | 1629356605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA CP048028T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010613A) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2025-07-28 |