| NPI | 1073119038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016413) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36477) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2023-03-08 |