| NPI | 1841492048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10002289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019516) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2012-06-13 |