| NPI | 1649085630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015894A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303776) |
| Enumeration Date | 2025-02-08 |
| Last Update Date | 2025-02-12 |