| NPI | 1083224331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR CP0044907) |
| 225100000X Physical Therapist (Licence: VA 2305213582) | |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2021-04-29 |