| NPI | 1144735671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16653) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA003644) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2025-11-12 |