| NPI | 1114328788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003078) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1241541) |
| Enumeration Date | 2014-09-14 |
| Last Update Date | 2021-02-26 |