| NPI | 1174991293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015092) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01570300) |
| Enumeration Date | 2015-09-05 |
| Last Update Date | 2021-04-21 |