| NPI | 1528209442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP051202T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT1495) |
| 225100000X Physical Therapist (Licence: AL PTH9093) | |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2026-04-20 |