| NPI | 1346586039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24491) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009218) |
| 225100000X Physical Therapist (Licence: DE J1-0002942) | |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2016-06-16 |