| NPI | 1356988620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1325703) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2025-06-25 |