| NPI | 1801310586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 15518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013061) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2024-08-13 |