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 |