| NPI | 1780723973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014870) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 6822) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2025-12-16 |