| NPI | 1912552852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015543A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34857) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2024-05-27 |