| NPI | 1689009805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012073A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006712) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2016-11-01 |