| NPI | 1174367353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017596) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 13287) |
| Enumeration Date | 2024-06-21 |
| Last Update Date | 2025-03-20 |