| NPI | 1932164498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0001313) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DE J10001313) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-05-22 |