| NPI | 1659840718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27471) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0004000) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2019-09-19 |