| NPI | 1740557719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05010732A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21892) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2024-04-15 |