| NPI | 1407248263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037492-1) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2021-10-25 |