| NPI | 1295015592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011389) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26257) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2021-03-25 |