| NPI | 1154754109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011170) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA PT011170) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2021-09-21 |