| NPI | 1215028337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE 0002600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT011776L) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-03-18 |