| NPI | 1386670222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10000230) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT010664L) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-03-21 |