| NPI | 1861638272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009531) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2022-01-21 |