| NPI | 1982785457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011579A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT28551) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2017-03-13 |