| NPI | 1285712620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002201) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-10-02 |