| NPI | 1346799145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294047) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2024-05-11 |