| NPI | 1578139911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10857) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015240) |
| 225100000X Physical Therapist (Licence: AZ CP008693T) | |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2023-01-27 |