| NPI | 1447787510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012845) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041192-1) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2022-03-20 |