| NPI | 1689916603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DE J1-0002978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002978) |
| 225100000X Physical Therapist (Licence: PA PT023376) | |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2018-03-12 |