| NPI | 1891000584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT-020831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0015075) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2025-07-28 |