| NPI | 1578569794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT006659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH5116) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-12-15 |