| NPI | 1871479899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013276) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1251862) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2025-08-14 |