| NPI | 1548692148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 30437) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011073) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2021-08-24 |