| NPI | 1376122697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 4371698) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2026-02-17 |