| NPI | 1538792536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014212) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10004) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-09-21 |