| NPI | 1093360943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015201) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9483) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2021-05-10 |