| NPI | 1528675113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP022580T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10735) |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2023-08-02 |