| NPI | 1134646433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014737) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14.011502) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2023-07-11 |