| NPI | 1871105700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015115) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9972) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2022-12-21 |