| NPI | 1518539527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE CP031224T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28416) |
| Enumeration Date | 2021-07-11 |
| Last Update Date | 2024-06-07 |