| NPI | 1720505340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012593A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13287PT) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2025-08-26 |