| NPI | 1639608110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012450A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211074) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-02-07 |