| NPI | 1114334059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208683) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2020-09-01 |