| NPI | 1710354626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011883A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038889) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2015-08-26 |