| NPI | 1912294232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012171) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: FL PT26462) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2026-05-01 |