| NPI | 1639694490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12261) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013054) |
| Enumeration Date | 2017-08-13 |
| Last Update Date | 2020-03-09 |