| NPI | 1144060997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014896) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2025-05-20 |