| NPI | 1942855218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013400A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 05013400A) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2020-07-16 |