| NPI | 1003544750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11462) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2023-01-20 |