| NPI | 1568990257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013873) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11458) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2021-04-01 |