| NPI | 1912996752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204261) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0001744) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2008-04-16 |