| NPI | 1366442352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP011273T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 2573) |
| Enumeration Date | 2005-07-31 |
| Last Update Date | 2022-05-17 |