| NPI | 1922834191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP052891T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT017400) |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2026-02-23 |