| NPI | 1679558092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05007614A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005057) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2019-01-30 |