| NPI | 1528021607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7226) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014283) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2022-06-15 |