| NPI | 1609620616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016742) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2026-02-25 |