| NPI | 1205471133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014495) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9980) |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2020-06-11 |