| NPI | 1487295283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6698) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2020-12-28 |