| NPI | 1649789066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043569) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2022-07-14 |