| NPI | 1952427221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011855A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06003839A) |
| 225200000X Physical Therapy Assistant (Licence: IL 160-004692) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2021-12-02 |