| NPI | 1447643077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209198) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2022-05-16 |