| NPI | 1083915748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206727) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2012-11-08 |