| NPI | 1922521228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT017039) |
| 225100000X Physical Therapist (Licence: CT 14.011450) | |
| 225100000X Physical Therapist (Licence: NY 041697) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-10-28 |