| NPI | 1477008191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12426) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2024-02-22 |