| NPI | 1154906865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015148) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12748) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2021-03-15 |