| NPI | 1700199569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013174) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 050103980A) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2019-09-17 |