| NPI | 1699711044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10001409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008320L) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2011-08-11 |