| NPI | 1720708233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014594) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2023-04-06 |