| 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 |