| NPI | 1881147544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012141A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06004669A) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-07-29 |