| NPI | 1902418197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14096) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013856A) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2022-03-29 |