| NPI | 1508234311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25657) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2018-03-17 |