| NPI | 1699033068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022116) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2013-11-15 |