| NPI | 1881636678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J100001507) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT011115L) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2013-03-04 |