| NPI | 1992307656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015107) |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2026-04-14 |