| NPI | 1073161436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015276) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6781) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2021-06-17 |