| NPI | 1164906897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013860) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2019-02-20 |