| NPI | 1467305110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE CP053686T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0135024) |
| Enumeration Date | 2026-02-20 |
| Last Update Date | 2026-02-20 |