| NPI | 1932732369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016973) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216110) |
| 225100000X Physical Therapist (Licence: PA PT028251) | |
| 225100000X Physical Therapist (Licence: KY 007919) | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2024-02-01 |