| NPI | 1669822698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4413) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-00020890) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2024-07-18 |