| NPI | 1164098927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015614) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT37229) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-09-28 |