| NPI | 1114324399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013722) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011679) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2021-05-18 |