| NPI | 1649819855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014455) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2025-01-14 |