| NPI | 1003190620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003356) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-021629) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2023-03-09 |