| NPI | 1154094720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP008837T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2022-04-29 |