| NPI | 1235556721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14739) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2021-02-05 |