| NPI | 1003490095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP005091T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2021-05-25 |