| NPI | 1972936318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011499A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12374-24) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2017-01-05 |