| NPI | 1770543027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013102) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-01-15 |