| NPI | 1578379301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017516) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP038724T) |
| Enumeration Date | 2024-12-06 |
| Last Update Date | 2025-01-27 |