| NPI | 1790399434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10775) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014812) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2024-10-04 |