| NPI | 1447618426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 039916) |
| 225100000X Physical Therapist (Licence: NC P21211) | |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2026-07-03 |