| NPI | 1598433252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015762) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214664) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2022-02-09 |