| NPI | 1053490318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10000278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 16007) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |