| NPI | 1245110014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTT43736) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT018118) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-11-25 |