| NPI | 1700198207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 16913) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002589) |
| 225100000X Physical Therapist (Licence: CO PTL-10393) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2026-04-10 |