| NPI | 1184822116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10002241) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23893) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2017-08-15 |