| NPI | 1780687053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10000534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT0052927L) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2015-09-30 |