| NPI | 1093548604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 6665) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07708) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2025-07-21 |