| NPI | 1508980830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0001243) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |