| NPI | 1669812970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4358) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT002016) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2018-03-12 |