| NPI | 1003302688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT8200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013618) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2022-11-22 |