| 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 |