| NPI | 1659577435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21911) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE j1-0002034) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2024-08-07 |