| NPI | 1508696816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP038611T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2024020648) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2025-03-14 |