| NPI | 1538512520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 012680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10883) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2017-02-20 |