| NPI | 1548292311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002563) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018143) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-05-07 |