| NPI | 1215488366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 31996) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2021-03-31 |