| NPI | 1669419958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT001125E) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0000460) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2008-04-04 |