| NPI | 1831863646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015448) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2025-09-02 |