| NPI | 1740758747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 15278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013770) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2025-01-10 |