| NPI | 1871128603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025697) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2021-01-18 |