| NPI | 1922278431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT0000006581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP055178T) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2026-05-11 |