| NPI | 1366715955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24762) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002819) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2019-01-29 |