| NPI | 1154583375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4715) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 3875) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2026-04-13 |