| NPI | 1629646013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IN 99104772A) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: IN 99104772A) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-06-14 |