| NPI | 1174119051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 015648) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 004356) |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2022-01-28 |