| NPI | 1972109510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014234) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 17406-24) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2025-10-23 |