| NPI | 1922374818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 27059) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2021-02-16 |