| NPI | 1073044772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003678) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2017-03-23 |