| NPI | 1548937279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014525) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029700) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2022-07-22 |