| NPI | 1225691488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0004185) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2022-10-24 |