| NPI | 1578072732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0004147) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 11280) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2020-06-19 |