| NPI | 1508978222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21230) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002174) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-07-21 |