| NPI | 1811360456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 078483) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2018-09-25 |