| NPI | 1497424188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT018368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT210002508) |
| 225100000X Physical Therapist (Licence: GA CP053690T) | |
| 225100000X Physical Therapist (Licence: AK 181171) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2026-08-03 |