| NPI | 1801525522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24050) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-06-09 |