| NPI | 1598371411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022037297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014971) |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2024-02-14 |