| NPI | 1982808747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05003421A) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: IN 05003421A) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-11-03 |