| NPI | 1669498341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 20048) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003399) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-06-09 |