| NPI | 1841754496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013523) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PY34079) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-07-03 |