| NPI | 1780209916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10014624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028709) |
| 225100000X Physical Therapist (Licence: PA TPT023340) | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2023-01-29 |