| NPI | 1225745276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 016359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 39369) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2025-08-22 |