| NPI | 1710631536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015763) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11177) |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2025-09-04 |