| NPI | 1073014684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015027) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2021-04-06 |