| 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 |