| NPI | 1831624766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012884) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2019-10-03 |