| NPI | 1366050262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 13115) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2025-05-15 |