| NPI | 1104852953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH3160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT005149) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-02-01 |