| NPI | 1912270398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6394) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015406) |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2022-10-21 |