| NPI | 1942718176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH8615) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2025-11-25 |