| NPI | 1902575640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015575) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2022-06-30 |