| NPI | 1740884824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014605) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT033432) |
| 225100000X Physical Therapist (Licence: MN 14066) | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2025-08-29 |