| NPI | 1821721689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP018230T) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2023-11-02 |