| NPI | 1912744855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP039482T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT017165) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2025-02-27 |