| NPI | 1407187594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8561) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2019-10-03 |