| NPI | 1417064445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017220) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 8012) |
| 225100000X Physical Therapist (Licence: AL PTH9151) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-08-06 |