| NPI | 1700335221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH8159) |
| 225100000X Physical Therapist (Licence: GA PT012738) | |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2022-04-08 |