| NPI | 1073086625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP035365T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0016146) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-10-15 |