| NPI | 1124650213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9760) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP045123T) |
| 225100000X Physical Therapist (Licence: MS PT6820) | |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2025-07-21 |