| NPI | 1356081590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP030657T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11144) |
| 225100000X Physical Therapist (Licence: TN 16318) | |
| 225100000X Physical Therapist (Licence: TX CP049748T) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-06-30 |