| NPI | 1831836931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014584A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-8117) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2023-03-23 |