| NPI | 1881651420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05008208A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9924-024) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-11-18 |