| NPI | 1144680588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003435) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25212) |
| 225100000X Physical Therapist (Licence: PA PT023610) | |
| Enumeration Date | 2016-02-27 |
| Last Update Date | 2016-02-27 |