| NPI | 1659305092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011714A) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 10165) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-11-14 |