| NPI | 1568830446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 1772) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2018-03-13 |