| NPI | 1952967986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014038) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: GA PT014038) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2025-05-05 |