| NPI | 1144024993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42844) |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2026-08-21 |