| NPI | 1588863062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0001996) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017627) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2011-02-28 |