| NPI | 1700498516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32924) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2025-09-04 |