| NPI | 1295061703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1192799) |
| 225100000X Physical Therapist (Licence: TN 8470) | |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2021-07-14 |