| NPI | 1346502341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010817) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9284) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2025-02-07 |