| NPI | 1861129199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030644) |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2024-12-09 |