| NPI | 1396384368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014428) |
| 225100000X Physical Therapist (Licence: TN 15372) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2024-07-15 |