| NPI | 1003152646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002414) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 22880) |
| Enumeration Date | 2013-01-01 |
| Last Update Date | 2013-01-01 |