| NPI | 1578949665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P98547) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2020-08-14 |