| NPI | 1407301138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012445) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2019-08-19 |