| NPI | 1790154292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE 0002689) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24036) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-01-16 |