| NPI | 1033594320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011925) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13082) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2025-07-11 |