| NPI | 1831708064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015936A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 100019) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2025-04-17 |