| NPI | 1134179674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 2178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010239) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2025-01-20 |