| NPI | 1508593799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12127) |
| Enumeration Date | 2022-08-06 |
| Last Update Date | 2023-02-08 |