| NPI | 1386195154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013382) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2025-04-22 |