| NPI | 1932714748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP004550T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 5626) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2021-03-19 |