| NPI | 1134166432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1001272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0001272) |
| 225100000X Physical Therapist (Licence: PA PT009185) | |
| 225100000X Physical Therapist (Licence: PA PT009185L) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-10-13 |