| NPI | 1174192009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017163) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P20553) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-10-16 |