| NPI | 1437432721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009417) |
| 225100000X Physical Therapist (Licence: NY 034293-1) | |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2024-09-09 |