| NPI | 1053890459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT13513) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA PT13513) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2022-04-08 |