| NPI | 1528483054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003143) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2014-02-20 |