| NPI | 1023556966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003663) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2024-12-20 |