| NPI | 1376039883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003927) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2022-02-12 |