| NPI | 1316936271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT012595L) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2013-03-14 |