| NPI | 1821022666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25934) |
| 225100000X Physical Therapist (Licence: PA PT005800L) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-12-18 |