| NPI | 1447075882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10981) |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2025-07-31 |