| NPI | 1467781922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021215) |
| Enumeration Date | 2009-12-12 |
| Last Update Date | 2014-08-04 |