| NPI | 1457967952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014826) |
| Enumeration Date | 2020-09-20 |
| Last Update Date | 2025-08-11 |