| NPI | 1336426832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13474) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010508) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2020-09-03 |