| NPI | 1790158970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10003530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024505) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2016-06-30 |