| NPI | 1780109546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11805) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05781) |
| 225100000X Physical Therapist (Licence: GA PT013059) | |
| Enumeration Date | 2017-08-13 |
| Last Update Date | 2018-04-27 |