| NPI | 1417268111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002626) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020577) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2014-07-09 |