| NPI | 1790750040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT008962L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002042) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2007-07-08 |