| NPI | 1821470709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011933) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10410) |
| 225100000X Physical Therapist (Licence: TX 1344068) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2025-04-25 |