| NPI | 1760092191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021003087) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2021-01-27 |