| NPI | 1447724539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014368) |
| 225100000X Physical Therapist (Licence: TN 12103) | |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2023-06-28 |