| NPI | 1336753177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10417) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014912) |
| 225100000X Physical Therapist (Licence: GA 014912) | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2020-09-14 |