| NPI | 1861914145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 013362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 32659) |
| 225100000X Physical Therapist (Licence: TN 10825) | |
| Enumeration Date | 2017-07-08 |
| Last Update Date | 2019-10-07 |