| NPI | 1679055479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8980) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17892) |
| 225100000X Physical Therapist (Licence: GA CP008272T) | |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2022-04-15 |