| NPI | 1760901565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013802) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209850) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2023-10-25 |