| NPI | 1760413181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05004153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27361) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-09-27 |