| NPI | 1902193279 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05014220A)  | 
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IN 05014220A)  | 
| 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501020021)  | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1208675)  | |
| Enumeration Date | 2011-07-06 | 
| Last Update Date | 2024-04-02 |