| NPI | 1023043346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10002156) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT9256) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-03-12 |