| NPI | 1477264869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049625) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2024-05-28 |