| NPI | 1891219192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11247) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013154) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2024-07-03 |