| NPI | 1780229468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014407) |
| Enumeration Date | 2019-11-17 |
| Last Update Date | 2022-06-09 |