| NPI | 1609793637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 7047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30779) |
| Enumeration Date | 2026-07-01 |
| Last Update Date | 2026-07-01 |