| NPI | 1083271233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12178) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2020-08-03 |