| NPI | 1467623603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT005002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD CP008424T) |
| Enumeration Date | 2008-03-16 |
| Last Update Date | 2021-11-13 |