| NPI | 1811725609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017582) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42021) |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2025-01-30 |