| NPI | 1356025076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT40316) |
| Enumeration Date | 2023-06-13 |
| Last Update Date | 2025-06-09 |