| NPI | 1003113242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE CP038708T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 5321) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2025-01-27 |