| NPI | 1487100616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 111970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0134914) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-01-23 |