| NPI | 1235019175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT018052) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-12-17 |