| NPI | 1639509284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012432A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14542) |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2023-08-30 |