| NPI | 1508298522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY CP008179T) |
| 225100000X Physical Therapist (Licence: TX 1244088) | |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2023-05-18 |