| NPI | 1851025878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23796) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016007) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-08-10 |