| NPI | 1992171797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP029522T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 09583R) |
| Enumeration Date | 2015-08-15 |
| Last Update Date | 2025-01-29 |