| NPI | 1730147232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT006145L) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2014-06-19 |