| NPI | 1629523238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11097) |
| 225100000X Physical Therapist (Licence: GA PT012673) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2018-10-04 |