| NPI | 1831624758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0003723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020672) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2017-05-12 |