| NPI | 1740901008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016260) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA OR252907) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2026-08-04 |