| NPI | 1609130905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT10659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010634) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2016-11-10 |