| NPI | 1306506621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015708) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047921) |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2022-01-04 |