| NPI | 1457760993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11021) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011625) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2021-01-19 |