| NPI | 1679074322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012807A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1303057) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2023-11-15 |