| NPI | 1700422383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028195) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2024-12-09 |