| NPI | 1033173000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT006344) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 416) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-10-27 |