| NPI | 1124272836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10004074) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MD T6408) |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2026-03-20 |