| NPI | 1831858018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22573) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015711) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-01-09 |