| NPI | 1902237977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011396A) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01527900) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2014-07-22 |