| NPI | 1427039262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE DEJ10001119) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 10974) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-07-08 |