| NPI | 1871141382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC CP038505T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014314) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2025-04-28 |