| NPI | 1932183787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005650A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005391) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2009-03-16 |