| NPI | 1821243205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11831) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2024-06-25 |