| NPI | 1114202397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009192) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2022-07-21 |