| NPI | 1629556717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000013536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013570) |
| 225100000X Physical Therapist (Licence: GA CP011119T) | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-03-13 |