| NPI | 1104283282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003440) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: IN 05014405A) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IN 05014405A) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2023-08-30 |