| NPI | 1306124151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010397) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2020-03-11 |