| NPI | 1801411061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12735) |
| Enumeration Date | 2020-06-13 |
| Last Update Date | 2020-07-09 |