| NPI | 1851543599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT9477) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2023-08-14 |