| NPI | 1225411457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11407) |
| 225100000X Physical Therapist (Licence: AL PTH6577) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2020-06-08 |