| NPI | 1780081497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN PT8541) |
| 225100000X Physical Therapist (Licence: AL PTH5694) | |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2015-08-10 |