| NPI | 1447329701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4329) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2026-07-22 |