| NPI | 1629779038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012144A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2023005159) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-07-06 |