| NPI | 1407320880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28369) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0004025) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2024-12-30 |