| NPI | 1013583335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO Pending) |
| 225100000X Physical Therapist (Licence: MO CP006299T) | |
| 225100000X Physical Therapist (Licence: TN 13736) | |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2022-01-17 |