| NPI | 1326649104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10598) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016394) |
| 225100000X Physical Therapist (Licence: NC P21888) | |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2025-08-07 |