| NPI | 1033687066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013768) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2020-10-07 |