| NPI | 1942630561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003638) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24818) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2021-12-15 |