| NPI | 1275170201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65517) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014269) |
| 225100000X Physical Therapist (Licence: TN 14668) | |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2025-02-17 |