| NPI | 1932052321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP053576T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CPO56327T) |
| 225100000X Physical Therapist (Licence: OH PT022198) | |
| Enumeration Date | 2026-02-17 |
| Last Update Date | 2026-06-15 |