| NPI | 1396270898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11720) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P20406) |
| 225100000X Physical Therapist (Licence: GA PT012798) | |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2024-10-11 |