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 |