| NPI | 1386429363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP052554T) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2026-03-02 |