| NPI | 1235616095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3761) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2023-09-15 |