| NPI | 1073331807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014962) |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2025-08-22 |