| NPI | 1598750176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002838) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015816) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2012-11-21 |