| NPI | 1225635907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP024532T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PT050579T) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2025-10-29 |