| NPI | 1760181754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1374658) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2025-01-16 |