| NPI | 1639528524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16362) |
| 225100000X Physical Therapist (Licence: SC 8232) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2018-06-01 |