| NPI | 1962078428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP032030T) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-08-27 |