| NPI | 1639992670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP046821T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH12099) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2025-08-20 |