| NPI | 1366639825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029641-1) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2023-02-24 |