| NPI | 1982129748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT872478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013106) |
| Enumeration Date | 2017-08-13 |
| Last Update Date | 2019-07-12 |