| NPI | 1306337621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9184) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2021-03-05 |