| NPI | 1366480212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 26300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016735) |
| 225100000X Physical Therapist (Licence: DE J1-0001822) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2018-11-06 |