| NPI | 1316676414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12151) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015957) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2024-08-06 |