| NPI | 1891413324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP036865T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14214) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2024-11-14 |