| NPI | 1205617321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016884) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP025623T) |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2023-10-13 |