| NPI | 1811191455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT006733) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 7844) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2026-07-01 |