| NPI | 1194124727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18733) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011536) |
| 225100000X Physical Therapist (Licence: SC CP033661T) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2025-03-26 |