| NPI | 1043942881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY CP051435T) |
| 225100000X Physical Therapist (Licence: MD 29081) | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-12-19 |