| NPI | 1932748209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0004165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41332) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2024-10-08 |