| NPI | 1780060194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11161) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2024-09-26 |