| NPI | 1427690726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP011913T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12522) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2022-06-29 |