| NPI | 1740773241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013898) |
| 225100000X Physical Therapist (Licence: AL PTH8912) | |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2019-06-20 |