| NPI | 1750047023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP011581T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 301177) |
| 225100000X Physical Therapist (Licence: OH PT018073) | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2022-06-22 |