| NPI | 1497125173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003793) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1263715) |
| 225100000X Physical Therapist (Licence: NJ 40QA01637100) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2021-10-24 |