| NPI | 1366869604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010803) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2025-05-01 |