| NPI | 1194136804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013835) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA001697) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2022-07-26 |