| NPI | 1508358417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH8898) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2020-02-18 |