| NPI | 1164376786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP053738T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0015161) |
| Enumeration Date | 2026-02-21 |
| Last Update Date | 2026-02-23 |