| NPI | 1376727628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27616) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA002429) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2019-08-27 |