| NPI | 1477589364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 17095) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10000896) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2008-04-20 |