| NPI | 1851620199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05009623A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH PT013140) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2025-01-07 |