| NPI | 1003594110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016616) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2024-09-05 |