| NPI | 1306556436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014627) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030994) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2023-02-10 |