| NPI | 1184464653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017576) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CT 12114) | |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2025-01-23 |