| NPI | 1598992760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010208) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5607) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2019-12-30 |