| NPI | 1972953578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10783) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-09-13 |