| NPI | 1366314858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE CP052501T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL89095) |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-01-23 |