| NPI | 1750862199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DE J1-0014294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1310846) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2021-08-19 |