| NPI | 1265281224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP039091T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PT23152) |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2025-02-11 |