| NPI | 1285090548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014557) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30071) |
| Enumeration Date | 2016-01-01 |
| Last Update Date | 2021-04-26 |