| NPI | 1093752974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT5405) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT7785) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2021-05-24 |