| NPI | 1346964004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030801) |
| 225100000X Physical Therapist (Licence: MD 29595) | |
| 225100000X Physical Therapist (Licence: SC 12310) | |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2024-10-08 |