| NPI | 1871910562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10778) |
| 225100000X Physical Therapist (Licence: TN 11031) | |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2016-10-19 |