| NPI | 1891160230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015003449) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2024-01-03 |