| NPI | 1649291816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12126) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: IN 05010267A) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2018-12-06 |