| NPI | 1952702433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9771) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014756) |
| 225100000X Physical Therapist (Licence: NC 6794) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2021-01-29 |