| NPI | 1073784591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP005028T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10074) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2021-05-18 |